COUNTER-CONDITIONING Also called _reciprocal inhibition_, this approach was developed by Joseph Wolpe (1915-1997), a Jewish psychiatrist trained in South Africa. Anxiety is offset by means of desensitization, assertiveness training, and sex therapy. As the basis for desensitization, deep relaxation is used to inhibit anxiety. Assertiveness training is used to counteract anxiety due to excessive shyness or aggressiveness by helping individuals form balanced habits of assertiveness that are neither submissive nor hostile. Sex therapy makes use of techniques of relaxation and desensitization to permit clients to feel sexual arousal and, in this way, to overcome sexual anxiety. {175} BEHAVIOR MODIFICATION This approach was derived from the work of American behaviorist B. F. Skinner (1904-1990) and others, who attempted to show that a great many emotional problems result from situations in which a person has been punished. He or she comes to fear these situations and develops emotional symptoms in an effort to escape from them. In behavior modification, attempts are made to change behavior through the use of rewards or punishments. COGNITIVE APPROACHES TO BEHAVIOR CHANGE These approaches make use of techniques developed outside of behavioral psychotherapy, especially those of Albert Ellis's rational-emotive therapy (see Chapter 10). These cognitive approaches are based on the belief that a person can gain control over undesirable behavior and psychosomatic problems by learning new habits of thinking. These three schools of behavioral psychotherapy claim that the problems leading people to enter therapy are _learned_ and can be unlearned through systematic training. In particular, anxiety--the primary source of emotional discomfort--can become a learned habit. When this happens, anxiety is linked to stimuli that in themselves are usually harmless. A person may come to feel extremely anxious, for example, when in the presence of people in authority, when in bed with a sex partner, when near dogs or insects, when criticized by others, when in a confined space, or in any number of other situations. Anxiety in these situations is learned, and it gradually becomes an involuntary habit. But the habit frequently can be broken and eliminated. WHAT BEHAVIORAL PSYCHOTHERAPY IS LIKE COUNTER-CONDITIONING When you are exposed to a situation that you believe is threatening, your blood pressure and pulse rate go up, your muscle tension increases, the blood supply to your large muscle groups increases, circulation to your stomach and genitals is {176} reduced, your pupils may dilate, your mouth may get dry. A startling noise or a physical shock can produce these symptoms. They are the physical manifestations of anxiety, and they are the focus of counter-conditioning techniques.